Efficacy of uterine artery embolization through a distal radial artery approach for treatment of uterine fibroids.

Objectives: Uterine fibroids are common benign tumors of the female reproductive system, primarily affecting women of childbearing age. These tumors worsen patients' quality of life and fertility. Current treatment options for symptomatic uterine fibroids include drug therapy, surgical intervention, and interventional procedures. Among these, uterine artery embolization (UAE) has emerged as an effective interventional treatment. Recently, the transradial approach (TRA) and the distal transradial artery approach (dTRA) have gained attention as alternative access routes for UAE. This study aims to compare the clinical efficacy of TRA and dTRA in UAE for the treatment of uterine fibroids, providing insight to guide clinical decision-making.

Methods: A retrospective, multi-center analysis was conducted involving 300 patients with uterine fibroids who underwent UAE between July 2021 and June 2024. Patients were divided into two groups based on the vascular access approach: the control group (n = 144, UAE via TRA) and the experimental group (n = 156, UAE via dTRA). Data on general patient characteristics, ovarian function indicators, perioperative data, postoperative visual analogue scale (VAS) pain scores, and complication rates were collected and analyzed. Multivariate logistic regression was used to identify factors associated with dTRA puncture failure, and a nomogram risk prediction model was constructed.

Results: The baseline characteristics of the two groups were comparable, with no significant differences in general information (P > 0.05). Also, no significant differences were observed in ovarian function indicators before and after surgery between the two groups (P > 0.05). However, the control group exhibited significantly shorter puncture and operation times compared to the experimental group (P < 0.05). The number of puncture attempts during the procedure was also lower, and the puncture success rate was higher in the control group (P < 0.05). Postoperative pain, as measured by the VAS score, was consistently lower in the experimental group at all time points (P < 0.05). The incidence of complications such as hypertonic hematoma of the right hand and forearm, radial artery spasm, and radial artery occlusion was significantly higher in the control group than in the experimental group (P < 0.05). Factors influencing dTRA puncture failure included vessel puncture inner diameter, radial artery tortuosity, and previous puncture history (P < 0.05), with vessel puncture inner diameter identified as the key determinant. A nomogram predictive model we constructed demonstrated strong reliability and is expected to assist in predicting puncture failure risk in clinical practice (P < 0.05).

Conclusions: Although the dTRA approach showed a lower puncture success rate compared to TRA, it demonstrated clear advantages in reducing postoperative complications and pain, significantly improving patient compliance. Future efforts should focus on optimizing operative technique to enhance the puncture success rate and expand the clinical use of dTRA, thereby providing more effective treatment options for uterine fibroids.